Effects of carvedilol on human prostate tissue contractility and stromal cell growth pointing to potential clinical implications.

BACKGROUND: Apart from antagonizing ß-adrenoceptors, carvedilol antagonizes vascular α1-adrenoceptors and activates G protein-independent signaling. Even though it is a commonly used antihypertensive and α1-adrenoceptors are essential for the treatment of voiding symptoms in benign prostatic hyperplasia, its actions in the human prostate are still unknown. Here, we examined carvedilol effects on contractions of human prostate tissues, and on stromal cell growth. METHODS: Contractions of prostate tissues from radical prostatectomy were induced by electric field stimulation (EFS) or α1-agonists. Growth-related functions were examined in cultured stromal cells. RESULTS: Concentration-response curves for phenylephrine, methoxamine and noradrenaline were right shifted by carvedilol (0.1-10 µM), around half a magnitude with 100 nM, half to one magnitude with 1 µM, and two magnitudes with 10 µM. Right shifts were reflected by increased EC50 values for agonists, with unchanged Emax values. EFS-induced contractions were reduced by 21-54% with 0.01-1 µM carvedilol, and by 94% by 10 µM. Colony numbers of stromal cells were increased by 500 nM, but reduced by 1-10 µM carvedilol, while all concentrations reduced colony size. Decreases in viability were time-dependent with 0.1-0.3 µM, but complete with 10 µM. Proliferation was slightly increased by 0.1-0.5 µM, but reduced with 1-10 µM. CONCLUSIONS: Carvedilol antagonizes α1-adrenoceptors in the human prostate, starting with concentrations in ranges of known plasma levels. In vitro, effect sizes resemble those of α1-blockers used for the treatment of voiding symptoms, which requires concentrations beyond plasma levels. Bidirectional and dynamic effects on the growth of stromal cells may be attributed to "biased agonism".

Effects of glyphosate-based herbicide on gametes fertilization and four developmental stages in Clarias gariepinus.

Comparative toxicology continues to provide information on how the age of every living organism affects the frequency, severity, and nature of the potentially toxic agent. We investigated the effect of glyphosate-based herbicide (GBH) exposure on gametes and four developmental stages of Clarius gariepinus (C. gariepinus) (African Catfish). Gametes from healthy gravid female and mature male C. gariepinus were exposed to GBH in sublethal concentrations of 0.0 (G1, control), 0.02 (G2), 0.05 (G3), 0.1 (G4), 0.5 (G5), and 1.0 (G6) mg/L for 24 h at the standard conditions of temperature and water quality parameters. The surviving embryos were examined microscopically for malformation rate and edema occurrence post-GBH exposure. In a separate experiment; postfryer, fingerling, posfingerling and juvenile C. gariepinus were exposed to G1, G2, G3, G4, G5 and G6 of GBH concentrations daily consecutively for 28 days. Fish growth performance, behavioural changes, haematology, oxidative stress, and histology were assessed. From our results, GBH showed altered morphology 24 h post-fertilization, decreased body weight, growth parameters, behavioural indices, and survival rate in the various developmental stages. Oxidative stress metabolite, malondialdehyde levels, increases in the postfryer > postfingerlin > fingerling > juvenile C. gariepinus following GBH exposure. Leukopenia and thrombocytosis were observed in the postfingerlings and juvenile fish and decrease in the levels of reduced glutathione and activity of superoxide dismutase compared with the control. Histology showed gross necrosis of the fish gills, liver, brain, and cardiac myocytes in the exposed fish. Hence, our findings provide an insight into C. gariepinus developmental toxicity due to GBH, although continuous measurement of glyphosate levels in the fish and fish environment is essential.

Ethyl acetate fraction of Spathodea campanulata (Bignoniaceae) attenuates lead acetate induced testicular toxicity in male Wistar rats.

OBJECTIVES: The use of Spathodea campanulata in folklore medicine for the management of reproductive disorders has been poorly reported. We sought to investigate the protective potential of the ethyl acetate fraction of S. campanulata stem bark extract (EFSC) on lead acetate-induced (LA) testicular toxicity in male rats. METHODS: Animals during a 28 days treatment received dimethyl sulfoxide (DMSO, 0.1%), LA (20 mg/kg), and EFSC (200 mg/kg). Others received EFSC only (100, 200, and 400 mg/kg) or vitamin E (100 mg/kg) 1 h prior to LA (20 mg/kg) administration. RESULTS: LA administration decreased sperm counts and motility by 36.39 and 40.69% respectively in rats. Also, LA-untreated rats showed elevated malondialdehyde (MDA) and decreased total proteins in testis (260, 33%) and epididymis (62, 29%) respectively. However, EFSC (100, 200, or 400 mg/kg) administrations improved sperm morphological characteristics as well as antioxidant status in LA-treated rats. EFSC (400 mg/kg) showed improved testis seminiferous tubules that were almost normal in the LA-treated rats. Further, EFSC contains a high 9-octadecenoic acid methyl ester. CONCLUSIONS: Overall, evidence by LA-induced testicular toxicity, EFSC provides chemopreventive roles via antioxidant mechanisms.

The use of combined high-fructose diet and glyphosate to model rats type 2 diabetes symptomatology.

An ideal food-chemical combination that will promote insulin resistance and its consequent development of pancreatic beta-cell dysfunction may open a new vista for Type 2 diabetes (T2D) research. Thus, we investigated the modulatory effects of a high-fructose diet (FRC) combined with glyphosate (GP). Male albino Wistar rats were randomly divided into five groups of eight/group and received distilled water, FRC, GP, and their combinations orally for eight consecutive weeks. We assessed the changes in fasting blood glucose levels (FBGLs), biochemical indices, oxidative stress parameters, and organ histopathology. From the results obtained, FBGLs and serum insulin levels were increased in the FRC-GP (2.3-3.1 and 1.9-2.2 folds) treated rats compared with the control baseline group. Also, the FRC-GP high dose increased FBGLs (1.9 folds), insulin (1.4 folds), triglycerides (1.5 folds), and uric acid (2 folds) levels compared with the FRC group. Malondialdehyde levels increased in the pancreas (54% and 78%) and liver (31.3% and 56.6%) of the FRC-GP treated rats. The FRC-GP treatments reduced serum high-density lipoprotein (57%), total protein (47%), and antioxidant parameters (non-enzymatic and enzymatic, 1.6-1.9 folds) respectively in the treated animals. The weight of the pancreas relative to the body increased (2-3 folds) while we observed mild inflammation and vascular congestion in vital organs in the treated rats. Overall, these results demonstrate the potential of FRC-GP-diet to induce conditions of rats T2D. Also, this novel finding suggests a cost-effective GP as an alternative in this model type and provides further insight into understanding FRC-GP interactions.

M3, a 1,4-Dihydropyridine Derivative and Mixed L-/T-Type Calcium Channel Blocker, Attenuates Isoproterenol-Induced Toxicity in Male Wistar Rats.

Recent evidence indicates that Ca2+ dysregulation is involved in the pathogenesis of isoproterenol (ISP)-induced biochemical toxicity and associated oxidative stress. In this study, we investigated the chemopreventive benefit of M3, a 1,4-dihydropyridine calcium channel blocker, against ISP-induced toxicity in male Wistar rats. Adult rats were divided into eight groups of six rats/group. Groups 1-5 received normal saline (control, 10 mL/kg/day, p.o.), ISP (85 mg/kg/day, s.c.), M3 lower dose (M3LD, 5 mg/kg, p.o.), M3 upper dose (M3UD, 20 mg/kg/day, p.o.), and Nifedipine (NFD, 20 mg/kg/day, p.o.), respectively. Others (groups 6-8) were pretreated with either M3LD, M3UD or NFD one hour before ISP administration. All rats were sacrificed 24 h after the last administration and changes in biochemical, hematological, and antioxidant parameters were assessed. Histologic examination of the heart, liver and kidney was also conducted. ISP elevated (p < 0.05) Ca2+, alanine aminotransferase, lactate dehydrogenase, triglycerides, and low-density lipoprotein levels when compared with control. Similarly, ISP increased levels of markers of renal function (p < 0.01), C-reactive protein (148.1%) and myocardial malondialdehyde (MDA, 88.7%) and tumor necrosis factor-alpha (109.2%). Platelet level was reduced (p < 0.05) in the ISP-intoxicated control rats. M3 exhibited antioxidant property, reduced levels of triglycerides, MDA and improved biochemical and hematological alterations associated with ISP toxicity. M3, however, was not effective in restoring histological changes that characterized ISP toxicity at the doses used. M3 offers chemopreventive benefits against ISP toxicity possibly through L-/T-type calcium channels blockade and modulatory actions on biochemical and antioxidant homeostasis.

Hepatoprotective and hematological effects of Justicia secunda Vahl leaves on carbon tetrachloride induced toxicity in rats.

Justicia secunda Vahl is an exotic plant that is used to treat medical problems. We investigated the hepatoprotective and hematological effects of aqueous extracts of J. secunda leaves on carbon tetrachloride induced toxicity in rats. Leaf extracts were prepared using hot and cold extraction methods to obtain a hot extract of J. secunda leaves (JSHAE) and a cold extract of J. secunda leaves (JSCAE). Total phenol and flavonoid measurements and antioxidant assays were performed to determine the extract with the greater antioxidant activity. JSHAE was the more effective extract for treatment of carbon tetrachloride (CCl4) induced hepatotoxicity and hepatotoxicity in rats. Silymarin was used as a standard for comparison. We found that JSHAE contained more total phenol and flavonoid than JSCAE. JSHAE exhibited significantly greater ferric reducing antioxidant power and 1,1-diphenyl-2-picryl hydrazyl and thiobarbituric acid scavenging activity than JSCAE. We also found that in vivo, 100 and 200 mg/kg JSHAE significantly reduced plasma aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase and total bilirubin levels following CCl4 induced toxicity compared to untreated rats. JSHAE treated animals exhibited white blood cell, red blood cell, hemoglobin, hematocrit, platelet and procalcitonin levels that were comparable to control animals. Liver sections of rats treated with 200 mg/kg. JSHAE exhibited no abnormalities.

Chemoprotective effects of butanol fraction of Buchholzia coriacea (Capparidaceae) against type 2 diabetes and oxidative stress in male Wistar rats.

Recent studies have shown that Type 2 diabetes (T2D) in rats can result through a synergy that links obesity to insulin resistance and ß-cell dysfunction. The present study achieved T2D via high fructose (20%w/v, p.o.), streptozotocin single dose (40 mg/kg, i.p.) (HFSTZ) in rats. Also, chemoprotective potential of butanol fraction of Buchholzia coriacea (BFBC) was demonstrated. Control normal and diabetic untreated (HFSTZ-induced T2D) rats received CM-cellulose (1 mg/kg, p.o.). Diabetic rats received intragastric BFBC (20, 200, 400 mg/kg), glibenclamide (0.07 mg/kg), and BFBC (200 mg/kg) plus glibenclamide treatments, respectively. 2,2-Diphenyl-1-picrylhydrazyl, nitric oxide radical, hydroxyl radical scavenging activities, and α-amylase inhibition were assessed. After 2 weeks of treatments, blood glucose levels, lipid profiles, renal and liver function, serum insulin as well as in vivo oxidative stress biomarkers were assessed. BFBC shows highest antioxidants and α-amylase inhibitory activities in vitro HFSTZ-induced T2D produced hyperglycemia (P<0.05-0.001; F = 5.26-26.47), serum hyperinsulinemia (six-folds) plus elevated lipid peroxidation levels. Similarly, there were altered lipid profiles, liver and renal biomarker enzymes plus weight loss. BFBC administration alone or in combination with glibenclamide reversed T2D symptomatologies in treated animals, and improved body weights against control diabetic rats. In vivo antioxidant activities also improved while histological sections in treated rats show reduced tissue damage in pancreas, kidneys, liver, and heart, respectively. Oleic, stearic, 2-methyl-pyrrolidine-2-carboxylic, and n-hexadecanoic acids were present in BFBC in large quantities given GC-MS analysis. Overall, data from the present study suggest chemoprotective potentials of BFBC against HFSTZ-induced T2D rats.

Protective Effects of Acridocarpus smeathmannii (DC.) Guill. & Perr. Root Extract against Phenylhydrazine-Induced Haematotoxicity, Biochemical Changes, and Oxidative Stress in Rats.

Several strategies for discovering drugs from unexplored natural products continue to strengthen research and development with current commercial evidence supporting their applications. We assessed the effects of the hydroethanolic extract of Acridocarpus smeathmannii root (HEASR) against phenylhydrazine (PHZ)-induced haematotoxicity, biochemical changes, and oxidative stress in male Wistar rats. Groups 1 and 2 controls received normal saline (10 mL/kg/day) and PHZ (60 mg/kg, day 4 and 5), respectively, via oral gavage. Groups 3, 4, and 5 were administered dexamethasone (DXM, 0.014 mg/kg/day, p.o.), HEASR1 (50 mg/kg/day, p.o.) and HEASR2 (200 mg/kg/day, p.o.), respectively. Groups 6, 7, and 8 received HEASR2 (200 mg/kg/day), DXM (0.014 mg/kg/day), or their combination, respectively, and further received PHZ (60 mg/kg/day) intervention on day 4 and 5 only. Treatments lasted for 7 days. Phenylhydrazine toxicity manifested as lowered haemoglobin, white blood cells, lymphocytes, red blood cells, and platelet levels by 45.86%, 53.47%, 75.69%, 46.89%, and 30.29%, respectively, in rats. This was accompanied by an increase in serum alanine (ALT; 108.25%) and aspartate (AST; 78.79%) aminotransferases, urea (84.36%), total cholesterol (81.55%), and triglycerides (123.42%) levels. Similarly, malondialdehyde levels and serum cyclooxygenase-2 activity were elevated (P < 0.05) in the rats liver and spleen, respectively. Just HEASR alone, or in combination with DXM, preserved haematological and biochemical parameters, cyclooxygenase-2 activity, and corticosterone levels during PHZ intoxication and restored renal histopathological alterations in rats. The HEASR was found to contain high flavonoid and phenolic phytochemicals and demonstrated better in vitro antioxidants inhibitory action.

Amlodipine, an L-type calcium channel blocker, protects against chlorpromazine-induced neurobehavioural deficits in mice.

This study investigated the modulatory and chemopreventive benefit of amlodipine (AML), a dihydropyridine calcium channel antagonist, against neurobehavioural abnormalities (NAs) associated with chlorpromazine (CPZ) toxicity in mice. Adult mice were divided into five groups of six animals/group. Group 1 (control) was administered saline (10 mL/kg i.p.). Group 2 received CPZ (2 mg/kg i.p.). Groups 3 and 4 received bromocriptine (BMC, 2.5 mg/kg s.c.) and AML (1 mg/kg s.c.), respectively, while group 5 received their combination. Groups 3-5 later received CPZ 30 min after initial treatments. Animals were subjected to neurobehavioural tests and euthanized 18 h later. CPZ-induced NAs were characterized by significant increase (P < 0.001) in cataleptic behaviour and lowered (P < 0.05) spontaneous activity reaction time in mice. There were also significant (P < 0.001) increases in malondialdehyde levels and decreased locomotion plus learning and memory parameters (P < 0.05-0.001). AML pretreatment alone did not alleviate CPZ-induced motor deficits in the mice. While pretreatment with BMC alone attenuated CPZ-associated catalepsy, its combination with AML further protected mice against NAs. Furthermore, BMC pretreatment did not affect CPZ-induced increase in malondialdehyde level, but AML or BMC+AML significantly (P < 0.05) decreased malondialdehyde in the CPZ-treated rats. Reduced glutathione levels and activities of superoxide dismutase and catalase remained elevated in all treatment groups. In conclusion, data from this study suggest possible chemopreventive benefit of AML alone or in combination with BMC against CPZ-associated neurobehavioural deficits. The ameliorative effect of AML may be related to its antioxidant and/or calcium channel blocking property.

Protective Effect of Curcumin against the Liver Toxicity Caused by Propanil in Rats.

We investigated the protective effects of curcumin on propanil-induced alterations in biochemical indices in blood and liver of male Wistar rats. The study consisted of four treatment groups, with six animals each, designated as control, propanil (20mg/kg), curcumin(50 mg/kg), and curcumin (50 mg/kg) + propanil (20 mg/kg). Rats were administered their respective doses orally, every other day, for 28 days. Propanil administration elicited significant (P < 0.001) increases in plasma aspartate aminotransferase and alkaline phosphatase activities, by 24% and 56%, respectively, compared to the control. Treatment with propanil elevated bilirubin, creatinine, and total cholesterol levels in rats, but these were not significant relative to controls. Administration of propanil to rats significantly (P < 0.001) increased lipid peroxidation levels. However, catalase activity, vitamin C, and reduced glutathione levels were significantly reduced. Exposure to propanil did not produce any significant changes in packed cell volume, neutrophils, and leukocyte counts. The supplementation of curcumin attenuated the adverse effects of propanil intoxication by reducing lipid peroxidation levels and restored the levels of serum enzymes and reduced glutathione. The present study showed that propanil increased oxidative stress and altered some biochemical parameters in the rats but curcumin could afford some protection to attenuate propanil-induced toxicity in the liver.

Modulation of paracetamol-induced hepatotoxicity by phosphodiesterase isozyme inhibition in rats: a preliminary study.

BACKGROUND: Altered regulation of nitric oxide-cyclic guanosine monophosphate (NO-cGMP) is present in liver cirrhosis. Several experimental studies have shown that selective modulation of NO metabolism in the liver reduces intrahepatic resistance and portal pressure in cirrhosis. This preliminary study investigated whether selective inhibition of phosphodiesterase-5 (PDE-5), which prevents the conversion of cGMP to 5'-GMP, as well as non-selective inhibition of PDE isozymes could ameliorate hepatic toxicity induced by paracetamol (PCM). METHODS: PCM (250 mg/kg, i.p.) was administered to induce hepatotoxicity. Control rats received physiological saline (10 mL/kg, p.o.), while sildenafil (a selective PDE-5 inhibitor) and aminophylline (a non-selective PDE inhibitor) were administered separately at 10 mg/kg p.o. to PCM-treated rats. RESULTS: PCM hepatotoxicity, characterized by elevation of aspartate and alanine aminotransferases, hepatic degeneration, and centrilobular necrosis, was attenuated by both PDE inhibitors. Sildenafil and aminophylline significantly (p<0.05) reduced plasma aspartate aminotransferase activity by 49.6% and 39.8%, respectively, with moderate increase in alanine aminotransferase activity by 26.1% and 20.4%, respectively, in PCM-treated rats. Decreases in total protein and albumin induced by PCM were significantly (p<0.05) prevented by 30.0% and 22.2%, respectively, following sildenafil administration, while aminophylline decreased these proteins by 14.0% and 25.9%, respectively. Sildenafil and aminophylline significantly (p<0.05) reduced lipid peroxidation by 30.7% and 19.7%, respectively, while moderately increasing glutathione (GSH) in the PCM-treated rats. Both drugs did not significantly alter the total cholesterol and triglyceride levels. CONCLUSIONS: These preliminary data suggest that pharmacological inhibition of PDE isozymes may be a useful strategy in protecting against PCM hepatic toxicity.

Celecoxib, a selective cyclooxygenase-2 inhibitor, lowers plasma cholesterol and attenuates hepatic lipid peroxidation during carbon-tetrachloride-associated hepatotoxicity in rats.

Cyclooxygenase-2 (COX-2) expression and prostaglandin production are suggested to play important, complex roles in the pathogenesis of various liver diseases. Studies on the effects of COX-2 inhibitors on the progression of liver fibrosis present controversial results, and the proposed therapeutic potential of these agents in chronic liver disease is predicated largely on their effectiveness in modulating hepatic stellate cell activation in vitro. This study investigated the modulatory effect of celecoxib, a selective COX-2 inhibitor, in CCl(4)-mediated hepatotoxicity in rats. Thirty Wistar albino rats, weighing 120-180 g, were assigned into five groups of 6 rats/group. Groups 1 and 2 received saline (10 mL/kg) and CCl(4) (80 mg/kg), respectively. Group 3 was given celecoxib (5.7 mg/kg), whereas groups 4 and 5 were pretreated with 2.9 and 5.7 mg/kg/day of celecoxib, respectively, 1 hour before CCl(4) treatment. Plasma aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase activities increased significantly by 118.5, 150.0, and 51.3%, respectively, with an accompanying decrease (P < 0.05) in total protein and albumin after CCl(4) treatment. Hepatotoxicity was associated with a significant increase in plasma cholesterol, hepatic lipid peroxidation (LPO), and severe hepatic necrosis with marked fatty and cellular (i.e., mononuclear cells) infiltration. Although celecoxib neither reduced CCl(4)-induced increases in marker enzymes of hepatotoxicity nor significantly attenuated hepatic necrosis, it, however, was effective in reducing elevated cholesterol by 16.5 and 20.8% and LPO by 12.9 and 35.5% at 2.9 and 5.7 mg/kg, respectively. Data suggest that COX-2 inhibitors may be effective in controlling hypercholesterolemia and peroxidative changes associated with liver injury.

Subacute therapeutic dosing of artemether-lumefantrine and artesunate-amodiaquine combination preserves plasma cholesterol, renal antioxidant status, and organ weights in rats.

Recent instances of breakdowns of malaria control programs and the constant emergence of drug-resistant parasites to monotherapies have shored up the use of artemisinin-based combination therapy (ACT) as the malaria therapy of choice. We evaluated a subacute therapeutic dosing of artemether-lumefantrine and artesunate-amodiaquine on plasma cholesterol, renal antioxidants, and organ weights in rats. Sixteen albino rats were grouped into three. Group A (n = 5) served as the control. Groups B (n = 6) and C (n = 5) were administered, twice daily, oral therapeutic doses of artemether-lumefantrine (1.14/6.86 mg/kg/d) and artesunate-amodiaquine (2.86/8.58 mg/kg/d), respectively, for seven days. From our results, ACTs did not significantly (P > 0.05) alter catalase, superoxide dismutase, glutathione S-transferase, myeloperoxidase, and total glutathione levels when compared with the control. Plasma total cholesterol levels also decreased insignificantly (P > 0.05). Organ-system weights were not significantly (P > 0.05) different from control rats. Artesunate-amodiaquine, but not artemether-lumefantrine, significantly increased (P < 0.05) lactate dehydrogenase activity and also afforded a 27.2% decrease in heart weight when compared with control. Also, both ACTs increased (P < 0.05) lipid peroxidation. Overall, artesunate-amodiaquine and artemether-lumefantrine may preserve renal antioxidants and organ weights in vivo. However, caution is required above therapeutic indications or in chronic doses as this may predispose to renal oxidative stress.

Pharmacologic inhibition of the renin-angiotensin system did not attenuate hepatic toxicity induced by carbon tetrachloride in rats.

The renin-angiotensin system (RAS) subserves vital physiological functions and also implicated in certain pathological states. Modulation of this system has been proposed in recent studies to be a promising strategy in treating liver fibrosis. We investigated the effect of the pharmacologic inhibition of RAS with angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in CCl(4)-induced liver injury with a view to ascertaining the chemopreventive benefit. Fifty-six Wistar albino rats were divided into eight experimental groups of seven rats/group. Groups 1-4 received normal saline (10 ml/kg), enalapril (0.6 mg/kg), losartan (1.4 mg/kg) and CCl(4) (80 mg/kg), respectively. Groups 5-8 were pretreated with enalapril (0.3 mg/kg), enalapril (0.6 mg/kg), losartan (0.7 mg/kg) and losartan (1.4 mg/kg) 1 hour before CCl(4) administration. Experiment lasted 11 days and dosing was via oral route. Rats were killed 24 hours after the last treatment. Serum activities of alkaline phosphatase, aspartate and alanine aminotransferases increased significantly (p < 0.05) by 46.0%, 90.6% and 122.3%, respectively, with severe hepatic centrilobular necrosis, fatty infiltration and increase in liver weight (p < 0.05) in the CCl(4)-treated rats. Enalapril (0.6 mg/kg) and losartan (1.4 mg/kg) significantly (p < 0.05) increased aspartate aminotransferase activity by 37.0% and 94.7% and produced mild centrilobular and periportal hepatic necrosis, respectively, with enalapril significantly (p < 0.05) increasing liver weight. Serum total cholesterol, triglyceride, albumin and total protein did not change significantly in these rats. Also, glutathione, malondialdehyde and uric acid levels were not significantly altered. Enalapril and losartan failed to attenuate liver injury associated with CCl(4) treatment. Although both drugs did not significantly alter serum biochemistry in the CCl(4)-treated rats, they however produced slight elevations in biomarkers of liver function and appear to worsen liver histopathology. Overall, the chemopreventive benefits of RAS inhibitors in liver disease remain doubtful and should be used with caution during hepatic dysfunction.